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How to Bill L&I

Help L&I provide the necessary care for the injured worker and pay you promptly.

Make sure the required documentation (reports, chart notes, etc.) is faxed or mailed correctly. L&I may deny or reduce payment if the required documentation is not provided or the level or type of service does not match the procedure code billed.

To reduce your claim (bill) delays, follow the suggestions below:

  • Put the L&I claim number in the top right corner of every page of each document.
  • Use only plain, white paper and do not highlight, to assure clear imaging.
  • Do not use address stamps or labels that are too large for a form.
  • Make sure documentation is legible.
  • Send reports and chart notes separately from bills. See addresses below.
  • Fax your chart documents to L&I, because faxed information goes directly to the claim file.

Mailing addresses

Billing documents
Billing documents
Document type Where to send your bills
Provider Account information including updates Department of Labor & Industries
PO Box 44261
Olympia, WA 98504-4261
All bills and adjustments Department of Labor & Industries
PO Box 44269
Olympia, WA 98504-4269
Refunds (attach copy of remittance advice) Department of Labor & Industries
PO Box 44835
Olympia, WA 98504-4835

Reports and chart notes
Reports and chart notes
Document type Where to send claim information
Report of Industrial Injury or Occupational Disease (F242-130-000)

Fax to: 800-941-2976, or
360-902-6690

OR mail it to:
Department of Labor & Industries
PO Box 44299
Olympia, WA 98504-4299

Correspondence; reports and chart notes (in SOAPER format) and claim related documents other than bills.

Fax to:
360-902-4567

OR mail it to:
Department of Labor & Industries
PO Box 44291
Olympia, WA 98504-4291


Chart notes and narrative reports require the following format

In workers' compensation there is a unique need for work status information. To meet this need it is suggested adding "ER" to the "SOAP" format.

SOAPER

Subjective complaints.

Objective findings.

Assessment.

Plan and progress.

Employment issues: Include a record of the patient's physical and medical ability to work, and information regarding any rehabilitation that the worker may need to undergo.

Restrictions to recovery: Any temporary or permanent physical limitations, and any unrelated condition(s) that may impede recovery.

Reports and Documents to submit

What documents are required by health care providers and when they are due.

Report and documents to submit
Document Due to L&I or
Self-Insurer
Report of Industrial Injury or Occupational Disease form (F242‑130‑000). To get form FAX the L&I warehouse at 360-902-4525 or email whse@lni.wa.gov. Immediately - within 5 days of first visit.
Self-Insurance: Provider's Initial Report (PIR) (F207-028-000). Immediately - within 5 days of first visit.
Sixty Day narrative - Support and document the need for continued care when conservative (nonsurgical) treatment is to continue beyond 60 days. Every 60 days.
Special Reports/Follow-up Reports narrative To update L&I on the treatment and status of your patients. As soon as possible following request by L&I or Self-Insurer.
Consultation Examination Reports narrative - Obtain an objective evaluation of the need for ongoing conservative medical management of the worker. The attending doctor may choose the consultant. At 120 days.
Attending Doctor Review of IME Report letter - Obtain the attending doctor's opinion about the accuracy of the diagnoses and information provided based on the Independent Medical Exam (IME). As soon as possible after receipt.
Time Loss Notification form (F242‑036‑555) - Certify the worker is off work and is eligible for time loss benefits.
To get form FAX the L&I warehouse at 360-902-4525 or email whse@lni.wa.gov.
As soon as possible after receipt.
Loss of Earning Power form (F242‑208‑000) - Certify the loss of earning power is due to the industrial injury/occupational disease.
To get form FAX the L&I warehouse at 360-902-4525 or email whse@lni.wa.gov.
As soon as possible after receipt.
Application to Reopen Claim Due to Worsening of Condition form (F242‑079‑000) - To notify L&I that the accepted condition has worsened and the claim needs to be reopened for additional treatment. Use this form if the claim has been closed for more than 60 days or for Crime Victims more than 90 days. Immediately.

For desk references

Get the Attending Doctor's Handbook (F252‑004‑000). You may also request a printed copy by emailing: detr235@Lni.wa.gov, or FAX your request to the warehouse at 360-902-4525.

To request a copy of the General Provider Billing Manual (F248‑100‑000), contact the Provider Hotline at: 1‑800‑848‑0811.

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